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Caring for People Covered by Both Medicare and Medicaid: A Primer on Dually Eligible Beneficiaries

Friday, June 03, 2011

This was an introductory session designed to inform the staff of new members of Congress both in Washington and in district or state offices about the people who receive benefits from both the Medicaid and Medicare programs (often called “dual eligibles”). The briefing was designed to be helpful to staff members unfamiliar with this important issue.

The nine million dually eligible beneficiaries are generally poorer and sicker than other Medicare beneficiaries, tend to use more health care services, and thus account for a disproportionate share of Medicare and Medicaid spending. Because they often have complex medical and long-term care needs and must navigate both Medicaid and Medicare benefits and financing, they present a special challenge for those seeking a more efficient and coordinated care delivery system. In this context, a good understanding of the needs and issues confronting care for dual eligibles will be essential to congressional health staff.

A distinguished panel addressed such basic questions as: Who is dually eligible for Medicare and Medicaid? What are the characteristics and needs of this population? How do Medicaid and Medicare coordinate payment and care for this population? What federal and state barriers complicate these efforts? What is being done to address these challenges? What provisions in health reform address improving the coordination and delivery of services for dual eligibles?

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